BP6348BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 6 3 4
(402) 426-4191 Permit
Application Date: ~ ~ Issue Date: 3 ~ ~ J Permit Fee: $
JOB ADDRESS ~ ~ ~ ~ ~ ~~
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2, OWNER • .(~ ~Y MAILADD ESS Zlp PHONE
3. CONTRA 0
/_ D ESS PHONE LICENSE N0.
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ,
], Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: Floodway Yes^
Fringe Yes^ No ^
No ^ Dev. Permil Elev. Cert.
BFE
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ No^
13. Special Use Permit Required: Yes ^ No ^
14. Variance Required: Yes^ No^
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes ^ No ^ Waiver Approved _
ACCEPTED.BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, and septic systems. By my signature below, I achnowledge that payment of the
building permit application fee does not constitute issuance of this building permit. I further
agree that construction covered by this permit application shall not be commenced until I
have received a copy of this application form signed bythe Building Inspector and stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications set forth
above and in accordance with the codesJordinances of the City of Blair and the State of
Nebraska. I understand that this permit is void if work is not commenced within 1 SO days
or is not com leted within 2 f to of issue.
NATURE OFOWNER/ NT TOR OR AUTHORIZ GENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
vU
Sewer ~ ~~ Water Service
Septic Remote
Building
Footings
Framing
Rough-in
Final
Drywall
(before Tinish)
i
Final 3''~ -`TS
Electrical
Temporary Service
Rough-in
Final -
Fixtures
Permanent Service
Mechanical
ABC _
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN TkI~SPA~€)-T.~-IIS IS YOUR PERMIT
Comment:
Approved
POUNDS PRTG: Blelr, NE Rev. 10/91
~-
t~ vim- .,BUILDING INSPECTION-REPORT
~~ _
1$ CITY OF BLAIR - ^ WASHWGT ~ COUNTY.:- ^ OTHER = ~'''
~ ._ _ ~ ~n _
_~ LQC~TION OF INSrECTION: ~ ~ ~ '~
Y _3
NAME OF OWNER: c ~ ~An ,.~ ~ ~ T~~ CONTRACTOR: _
DATE INSPECTION REQUESTED: / 4 PERMIT NO:
'; a TIME_INSPECTION REQUESTED:
TYPE OF INSPECTION REQUESTED:. _.
BUILDING: ~
^ FOOTING ^ FRAMING ^ DRYWALL ^ FINAL
UTILITIES:
^ SEWER TAP - - SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ^ WATER SERVICE
ELECTRICAL: -. _
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANENT SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
^ ROUGH-IN ^ A/C ^ FINAL
PLUMBING: ..
,^ GROUNDWORK ^ ROUGH-W ^ FINAL
RESULTS OF THE INSPECTION: ~ASSED (s~rro~s) ^ FAILED (sEE xo~s>